Fletcher G H, McNeese M D, Oswald M J
Department of Clinical Radiotherapy, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Int J Radiat Oncol Biol Phys. 1989 Jul;17(1):11-4. doi: 10.1016/0360-3016(89)90363-5.
Between 1963 and 1977, 941 patients with carcinoma of the breast received, at the University of Texas M.D. Anderson Cancer Center, peripheral lymphatic irradiation alone or with chest wall irradiation after a radical or modified radical mastectomy. None of the patients received adjuvant chemotherapy. The incidence of patients with histologically involved axillary nodes was 70%. The lymphatics of the apex of the axilla, of the supraclavicular area, and of the internal mammary chain were irradiated in patients with histologically positive axillary nodes and/or in patients with central or inner quadrant primaries regardless of the axillary status. When in 1963 an electron beam became available, chest wall irradiation has been added to the peripheral lymphatics irradiation, primarily when there was a heavy infestation of the axillary nodes. The disease-free survival curves tend to flatten out at 10 years. At 10 and 20 years, the disease-free survival rates are respectively 55% and 50% for all patients, 44% and 40% for all patients with positive nodes, 56% and 48% for the patients with one to three positive nodes, and 33% and 30% for the patients with four or more positive nodes. The comparison of the mortality curves between the general population and the breast cancer patients seems to indicate a cured fraction, since the curves become parallel at 17 years. The highest incidence of failures is between 0 and 5 years, still a significant incidence between 5 and 10 years, but after 10 years the incidence of failures is relatively small.
1963年至1977年间，941例乳腺癌患者在德克萨斯大学MD安德森癌症中心接受了根治性或改良根治性乳房切除术后单独的外周淋巴照射或联合胸壁照射。所有患者均未接受辅助化疗。组织学检查发现腋窝淋巴结受累的患者比例为70%。对于组织学检查腋窝淋巴结阳性的患者和/或中央或内象限原发性肿瘤的患者，无论腋窝状态如何，均对腋窝尖、锁骨上区域和乳房内链的淋巴管进行照射。1963年有电子束可用后，胸壁照射被添加到外周淋巴照射中，主要是在腋窝淋巴结重度受累的情况下。无病生存曲线在10年后趋于平缓。在10年和20年时，所有患者的无病生存率分别为55%和50%，所有淋巴结阳性患者为44%和40%，1至3个阳性淋巴结患者为56%和48%，4个或更多阳性淋巴结患者为33%和30%。普通人群与乳腺癌患者死亡率曲线的比较似乎表明有一部分患者被治愈，因为两条曲线在17年后变得平行。失败发生率最高的时间段是0至5年，5至10年仍有显著发生率，但10年后失败发生率相对较小。
